Sir,

We thank Dr Dave for his valuable comments and suggestions and appreciate his interest in our manuscript.1 We agree with the author that it would be appropriate to also provide the median value for the number of prior injections and duration of treatment, in addition to the standard deviation. The study included patients who had received 23.8±18.8 (median 21.5) prior ranibizumab or bevacizumab injections over the previous 28±20.5 (median 24) months.

We agree with the author that an assessment of the normality of data is a prerequisite for several statistical tests because normal data is an underlying assumption in parametric testing. The quantitative variables for the treatment interval between the two groups were examined by the Shapiro–Wilk test to determine the distribution, which was found to be normal. Because data was normally distributed, the paired test was used. The mean interval between aflibercept injections was 59.3±7.6 days and that between ranibizumab/bevacizumab was 37±6.1 days.

We also agree that 4 injections are insufficient to label a patient as recalcitrant. Our study looked at eyes with ≥6 prior intravitreal ranibizumab and or bevacizumab injections. We apologize for typographical error incorrectly mentioning the range, which should read 6–62 injections.

The treatment protocol followed in this study was 3-monthly aflibercept injections followed by treatment at a generally fixed interval of 8 weeks, further extended by 2-week intervals at the discretion of the treating physician based on persistent/recurrent intraretinal fluid (IRF)/subretinal fluid (SRF)/sub-retinal pigment epithelium (RPE) fluid, new hemorrhage/SRF/IRF on exam, increase in central subfoveal thickness (CFT) >100 μm and worsening vision by >1 Snellen line. However, as this was a retrospective study, treatment decisions were not absolutely standardized. The range of interval between aflibercept injections was 35–133 days as mentioned in the abstract. There was a single patient who was administered a repeat intravitreal aflibercept injection at 35 days (ie, before 8 weeks).

We appreciate the author’s comments and insight into our study. Given the burden imposed by monthly anti-VEGF treatment and the compounded risk of potential adverse ocular and systemic events, conversion to aflibercept offers an approach to increase treatment interval until such time that long-term drug delivery implants are available. Future, prospective studies with a larger sample size are required to confirm the findings of our initial study and also to potentially identify anatomical characteristics that would be predictive of eyes that might require fewer injections.